Age and Upper Airway Obstruction: A Challenge to the Clinical Approach in Pediatric Patients

Nosetti Luana, Zaffanello Marco, Francesca De Bernardi, Piacentini Giorgio, Roberto Giulia, Salvatore Silvia, Simoncini Daniela, Pietrobelli Angelo and Agosti Massimo
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Nosetti Luana: Division of Pediatrics, “F. Del Ponte” Hospital, University of Insubria, 21100 Varese, Italy
Zaffanello Marco: Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37134 Verona, Italy
Francesca De Bernardi: Department of Otorhinolaryngology, University of Insubria and ASST Sette Laghi, Ospedale di Circolo, 21100 Varese, Italy
Piacentini Giorgio: Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37134 Verona, Italy
Roberto Giulia: Division of Pediatrics, “F. Del Ponte” Hospital, University of Insubria, 21100 Varese, Italy
Salvatore Silvia: Division of Pediatrics, “F. Del Ponte” Hospital, University of Insubria, 21100 Varese, Italy
Simoncini Daniela: Division of Pediatrics, “F. Del Ponte” Hospital, University of Insubria, 21100 Varese, Italy
Pietrobelli Angelo: Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37134 Verona, Italy
Agosti Massimo: Division of Neonatology and Neonatal Intensive Care Unit, “F. Del Ponte” Hospital, 21100 Varese, Italy

IJERPH, 2020, vol. 17, issue 10, 1-9

Abstract: Upper airway abnormalities increase the risk of pediatric morbidity in infants. A multidisciplinary approach to obstructive sleep apnea syndrome (OSAS) poses challenges to clinical practice. The incidence and causes of OSA are poorly studied in children under 2 years of age. To fill this gap, we performed this retrospective observational study to determine the causes of obstructive sleep apnea (OSA) in children admitted to our hospital between January 2016 and February 2018, after a brief unexplained event (BRUE) or for OSA. We reviewed the medical charts of 82 patients (39 males; BRUE n = 48; OSAS n = 34) and divided them into two age groups: < 1 year old (1–12 months; n = 59) and >1 year old (>12–24 months; n = 23). Assessment included nap polysomnography, multichannel intraluminal impedance-pH, and nasopharyngoscopy. Sleep disordered breathing was comparable between the two groups. Omega-shaped epiglottis, laryngomalacia, and nasal septum deviation were more frequent in the younger group, and nasal congestion in older group. Tonsillar and adenoidal hypertrophy was more frequent in the older group, while laryngomalacia and gastroesophageal reflux was more frequent in the younger group. Tonsil and adenoid size were associated with grade of apnea-hypopnea index severity in the older group, and laryngomalacia and gastroesophageal reflux in the younger group. The main causes of respiratory sleep disorders differ in children before or after age 1 year. Our findings have potential clinical utility for assessing the pathophysiology of obstructive sleep disordered breathing in patients less than 2 years old.

Keywords: brief resolved unexplained event; gastro-esophageal reflux; infants; laryngomalacia; obstructive sleep disordered breathing; polysomnography (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2020
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